Nursing education pilot examines how learning format shapes sustainability agency in the operating theatre
Surgical care sits at the center of a paradox: it saves lives while also driving a substantial share of healthcare’s environmental burden. Operating theatre departments consume large amounts of energy and resources, making perioperative practice a logical target for sustainability training. This mixed-methods, randomised pilot study is designed to test whether different learning formats can strengthen professional agency among nursing students and practitioners engaged in perioperative sustainability education.
The protocol is notable for pairing an educational intervention with a clearly defined theoretical frame. By integrating professional agency and sustainability competencies, the investigators are not simply asking whether participants liked the teaching format. They are asking whether the format changes how learners reflect, interpret responsibility, and imagine action within a high-resource clinical environment. In perioperative care, where routines are deeply embedded and decision-making is often constrained by workflow and safety culture, the capacity to recognize environmental consequences and act on them may be as important as knowledge itself.
A mixed-methods pilot built around reflection, not just recall
The study uses a mixed-methods design and draws on multiple qualitative and quantitative data sources. That approach matters because sustainability education is difficult to capture with a single measure. A brief knowledge test may miss whether a learner can connect environmental harm with everyday clinical choices, while a narrative reflection may reveal insight without proving durability in practice. By combining methods, the protocol aims to build a more textured picture of how participants respond to the teaching intervention.
A strong feature of the design is the explicit analytical framework. The protocol states that the framework is theoretically informed and transparent, which gives structure to a topic that can otherwise drift into vague educational enthusiasm. In practical terms, the investigators plan to analyze articulated reflections, not merely whether learners can repeat environmental facts. That distinction is important in perioperative nursing, where professional judgment often depends on seeing the hidden impact of routine actions—energy use, waste generation, and the environmental cost of standard equipment choices.
The study is a pilot, and that shapes what can and cannot be claimed. It is not powered for statistical inference, so the results should not be read as definitive evidence that one learning format is superior. Instead, the value lies in feasibility, signal detection, and the quality of the reflective material generated by participants. The design is well suited to early educational research in a field where the outcome of interest is still being defined.
Why perioperative sustainability is a nursing education problem
Perioperative sustainability is not a niche concern limited to facility managers or environmental committees. Nursing staff work at the point where many resource-intensive decisions are enacted: selection, use, disposal, and coordination of supplies; maintenance of energy-intensive sterile environments; and adherence to protocols that may be clinically necessary but environmentally costly. If sustainability is to become part of routine practice, education has to reach the level of professional identity, not just policy awareness.
Professional agency is a useful construct here because it captures whether learners feel able to act, question, and influence practice within a constrained system. In a surgical setting, agency may determine whether a nurse merely follows the default pathway or notices opportunities for lower-impact practice without compromising safety. The protocol’s focus on reflective processes suggests an effort to understand whether education can move participants from passive reception to active professional interpretation.
One sentence captures the entire problem: if the learner cannot imagine acting, the lesson stays academic.
Bias, contamination, and the limits of a real-world pilot
The protocol is candid about the study’s constraints. Voluntary participation in post-session data collection may introduce response bias, particularly if those most interested in sustainability are more likely to complete follow-up reflections. That would inflate enthusiasm and make the learning format look more effective than it is in a broader audience. The study also acknowledges the possibility of cross-contamination between groups, a realistic risk in educational environments where participants may discuss course content outside the session.
Lack of blinding adds another layer of interpretive caution. In a trial of educational formats, participants and facilitators often know which intervention is being delivered, and that awareness can shape both participation and reporting. Even so, the absence of blinding does not invalidate the work; it simply narrows the claims. The most defensible conclusions will probably center on acceptability, feasibility, and the nature of reflective change rather than on any hard claim of superiority.
A second limitation is equally important: the analysis focuses on articulated reflections rather than observed behavior. That means the study can show what learners say and write about sustainability, but not whether those reflections alter conduct in the operating theatre. Translating awareness into bedside or theater-floor practice is a different challenge altogether, especially in environments governed by infection control, hierarchy, and time pressure.
What this protocol can still contribute to the field
Even without statistical power for inferential claims, the study may offer a useful template for future work. Educational interventions in sustainability are often evaluated with broad satisfaction measures or generic knowledge assessments. This protocol reaches closer to the mechanisms that matter in practice: how learning formats shape reflection, and how reflection may support agency in a system with entrenched routines.
The international collaborative setting also broadens the conceptual reach of the project. Perioperative sustainability is not unique to one country or one healthcare system, and educational models that work across settings may be more adaptable than locally tailored modules with narrow transferability. Still, transferability will depend on context. Surgical workflow, institutional priorities, and the local culture of nursing education can all affect how a sustainability lesson lands and what kind of agency it produces.
The protocol is careful not to overclaim. That restraint is appropriate. Early-stage educational research should establish whether a concept can be taught, whether the learning format is workable, and whether the resulting reflections are rich enough to justify a larger study. Here, the most useful outcome may be a clearer map of how nurses think about environmental responsibility inside perioperative care, and which educational structures help them articulate that responsibility with confidence.
A feasibility question before a practice-change question
The next step is not whether this study will prove that one format is best for all learners. The more immediate question is whether a theoretically grounded educational design can generate measurable, meaningful reflections in a space where sustainability has too often been peripheral. If the pilot produces usable data, it could support a larger trial with stronger endpoints and tighter control of contamination and response bias.
For now, the protocol marks an important methodological move: it treats sustainability competence as something that can be cultivated through professional education, not merely appended to it. In perioperative nursing, where environmental burden is built into routine care, that is a necessary place to begin.